1 of 4Consent Advice 1 © RCOG 2009

Royal College of Obstetriciansand Gynaecologists

Consent Advice No. 1December 2008

DIAGNOSTIC HYSTEROSCOPY UNDER GENERAL ANAESTHESIA

This is the second edition of this guidance, which was previously published in October 2004 under thesame title.

This paper provides advice for clinicians in obtaining the consent of women undergoing diagnostichysteroscopy under general anaesthesia. It follows the structure of Consent Form 1 of the Departmentof Health, England/Welsh Assembly Government/Scottish Government/Department of Health, SocialServices and Public Safety, Northern Ireland. It should be used in conjunction with RCOG ClinicalGovernance Advice, Obtaining Valid Consent.1

The aim of this advice is to ensure that all women are given consistent and adequate information forconsent; it is intended to be used together with dedicated patient information. After discharge, allwomen should have clear direction to obtain help if there are unforeseen problems.

Clinicians should be prepared to discuss with the woman any of the points listed on the followingpages.

The above descriptors are based on the RCOG Clinical Governance Advice, Presenting Information on Risk.2 They

are used throughout this document.

To assist clinicians at a local level, we have included at the end of this document a fully printable page2 of the Department of Health, England/Welsh Assembly Government/Scottish Government/Depart-ment of Health, Social Services and Public Safety, Northern Ireland, Consent Form 1. This page can beincorporated into local trust documents, subject to local trust governance approval.

Presenting information on risk

Term Equivalent numerical ratio Colloquial equivalent

Very common 1/1 to 1/10 A person in family

Common 1/10 to 1/100 A person in street

Uncommon 1/100 to 1/1000 A person in village

Rare 1/1000 to 1/10 000 A person in small town

Very rare Less than 1/10 000 A person in large town

CONSENT FORM

1. Name of proposed procedure or course of treatmentDiagnostic hysteroscopy under general anaesthesia.

2. The proposed procedureDescribe the nature of hysteroscopy. Explain the procedure as described in the patient information.

Note: If any other procedures are anticipated (such as endometrial biopsy, removal of polyp, insertion oflevonorgestrel-releasing intrauterine system, treatment of fibroids or division of adhesions) these must bediscussed and a separate consent obtained.

3. Intended benefitsTo find the cause of symptoms; as it is a diagnostic procedure it will not alter symptoms unless additionalprocedures are anticipated. Occasionally, a minor procedure is appropriate to treat some of the identifiedcauses or relieve the symptoms.

4. Serious and frequently occurring riskIt is recommended that clinicians make every effort to separate serious from frequently occurring risks.Women who are obese, who have significant pathology, who have undergone previous surgery or who havepre-existing medical conditions must understand that the quoted risks for serious or frequent complicationswill be increased. The risk of serious complications also increases if an additional therapeutic procedure isperformed. Women should be advised that hysteroscopy may not identify an obvious cause for presentingcomplaint.

4.1 Serious risksSerious risks include:3

● The overall risk of serious complications from diagnostic hysteroscopy is approximately two women in every

1000 (uncommon)

● Damage to the uterus (uncommon)

● Damage to bowel, bladder or major blood vessels (rare)

● Failure to gain entry to uterine cavity and complete intended procedure (uncommon)

● Infertility (rare)

● three to eight women in every 100 000 undergoing hysteroscopy die as a result of complications

(very rare).

4.2 Frequent risksFrequent risks include:● infection

● bleeding.

5. Any extra procedures which may become necessary during the procedureLaparoscopy or laparotomy in the event of perforation.

6. What the procedure is likely to involve; the benefits and risks of any available alternativetreatments, including no treatment

Vaginal approach and insertion of a hysteroscope through the cervix. The role of endometrial biopsy andpelvic ultrasound should be discussed along with the option of no investigation.

Consent Advice 12 of 4

7. Statement of patient: procedures which should not be carried out without furtherdiscussion

Other procedures which may be appropriate but not essential at the time should be discussed and the woman’swishes recorded.

8. Preoperative informationA record should be made of any sources of information (e.g. RCOG or locally produced informationleaflets/tapes) given to the woman prior to surgery.

9. AnaesthesiaWhere possible, the woman must be aware of the form of anaesthesia planned and be given an opportunity todiscuss this in detail with the anaesthetist before surgery. It should be noted that, with obesity, there areincreased risks, both surgical and anaesthetic.

References

1. Royal College of Obstetricians and Gynaecologists. Obtaining Valid Consent. Clinical Governance Advice No. 6. London: RCOG; 2008[www.rcog.org.uk/womens-health/clinical-guidance/obtaining-valid-consent].

2. Royal College of Obstetricians and Gynaecologists. Presenting Information on Risk. Clinical Governance Advice No. 7. London: RCOG; 2009[www.rcog.org.uk/womens-health/clinical-guidance/presenting-information-risk].

3. Jansen FW, Vredevoogd CB, van Ulzen K, Hermans J, Trimbos JB, Trimbos-Kemper TC. Complications of hysteroscopy: a prospective,multicenter study. Obstet Gynecol 2000;96:266–70.

Consent Advice review process will commence in2012 unless otherwise indicated

This Consent Advice was produced by Dr MD Read FRCOG, Gloucester, with the support of the Consent Group of the Royal College ofObstetricians and Gynaecologists.Peer reviewed by:Dr SIMF Ismail MRCOG, Yeovil, and RCOG Consumers’ Forum

The final version is the responsibility of the Consent Group of the RCOG.

3 of 4Consent Advice 1 © RCOG 2009

DISCLAIMER

The Royal College of Obstetricians and Gynaecologists produces consent advice as an aid to good clinical practice. Theultimate implementation of a particular clinical procedure or treatment plan must be made by the doctor or otherattendant after the valid consent of the patient in the light of clinical data and the diagnostic and treatment optionsavailable. The responsibility for clinical management rests with the practitioner and their employing authority and shouldsatisfy local clinical governance probity.

Patient identifier/label

Name of proposed procedure or course of treatment(include brief explanation if medical term not clear)

Statement of health professional (to be filled in by health professional withappropriate knowledge of proposed procedure, as specified in consent policy)I have explained the procedure to the patient, in particular, I have explained:

The intended benefits:

Serious risks:

Frequent risks:

Any extra procedures which may become necessary during the procedure

blood transfusion

other procedure (please specify)

I have also discussed what the procedure is likely to involve, the benefits and risks of any availablealternative treatments (including no treatment) and any particular concerns of this patient.

The following leaflet/tape has been provided

This procedure will involve:

general and/or regional anaesthesia local anaesthesia sedation

Signed ........................................................................................ Date....................................................................

Name (PRINT) ............................................................................ Job title ............................................................

Contact details (if patient wishes to discuss options later)

Statement of interpreter (where appropriate)I have interpreted the information above to the patient to the best of my ability and in a way inwhich I believe s/he can understand

Signed ........................................................................................ Date....................................................................

Name (PRINT)................................................................................................................................................................

Top copy accepted by patient: yes/no (please ring)

Diagnostic hysteroscopy under general anaesthesia.

To find the cause of symptoms although sometimes no cause may be found. As it is adiagnostic procedure, it will not alter symptoms unless additional procedures are anticipated. Occasionally aminor procedure is appropriate to treat some of the identified causes or relieve the symptoms.

● The overall risk of serious complications from diagnostic hysteroscopy is approximately 2 women in every1000 (uncommon)

● Damage to the uterus (uncommon)● Damage to bowel, bladder or major blood vessels (rare)● Failure to gain entry to uterine cavity and complete intended procedure (uncommon)● Infertility (rare)● 3 to 8 women in every 100 000 undergoing hysteroscopy die as a result of complications (very rare)

● Infection● Bleeding

Laparoscopy or laparotomy in the event of perforation

(very rare)